The incidence of endometrial adenocarcinoma in asymptomatic women is low. Nevertheless, some of these women might require endometrial surveillance. In this study, we evaluated the accuracy of liquid-based endometrial cytology compared to biopsy in asymptomatic postmenopausal women. Three hundred twenty women scheduled for hysteroscopy were enrolled for this study. After hysteroscopy, patients were submitted to endometrial cytology and to biopsy. Two hundred ninety-three (92%) women had sonographically thickened endometrium (>5 mm), 53 (17%) were on tamoxifen, and 16 (5%) were on hormonal substitutive treatment. The evaluation of the biopsies determined that six (2%) women had adenocarcinoma, one (<1%) had adenomatous atypical hyperplasia, and eight (3%) had simple nonatypical hyperplasia. Endometrial cytology evidenced 5 (2%) neoplastic cases, 2 (<1%) hyperplastic with atypia cases, and 25 (8%) hyperplastic without atypia cases. Two hundred twenty-two biopsies (69%) and 17 (5%) cytologies were inadequate. One adenocarcinoma and one simple nonatypical hyperplasia were underrated by cytology resulting, respectively, as atypical hyperplasia and as negative. Four cases were false positive (simple nonatypical hyperplasias on cytology, negative on biopsy). The sensitivity and specificity were estimated, respectively, at 94% and 95%; the positive and negative predictive value were estimated, respectively, at 80% and 99%. Endometrial cytology provided sufficient material more often than biopsy (P < 0.01). We suggest to introduce liquid-based endometrial cytology in the management of some subpopulations of asymptomatic postmenopausal women. Particularly, the combination of liquid-based endometrial cytology and transvaginal sonography may improve their diagnostic accuracy and reduce unnecessary more invasive and expensive procedures.

Liquid-based endometrial cytology: cyto-histological correlation in a population of 917 women Objective: Liquid-based cytology, because of its capacity to reduce the obscuring factors and to provide thin-layer specimens, represents an opportunity to reevaluate endometrial cytology. In order to assess the utility of the liquid-based method in endometrial diagnosis, we evaluated its accuracy in comparison with histology. Methods: Nine hundred and seventeen women scheduled for hysteroscopy were enrolled in the study. After providing informed consent, all the women proceeded sequentially to hysteroscopy, endometrial cytology and then biopsy endometrial sampling. Results: Cyto-histological correlations were possible in 519 cases (57%): in 361 (39%) cases the biopsy was inadequate, in 15 (2%) the cytology was inadequate, and in 22 (2%) both were inadequate. At biopsy 25 (3%) women had adenocarcinoma, 5 (1%) had adenomatous atypical hyperplasia and 21 (2%) had simple non atypical hyperplasia. At cytology two adenocarcinomas and one adenomatous atypical hyperplasia were underrated as atypical hyperplasias and as non-atypical hyperplasia; two simple non-atypical hyperplasias were reported as negative; and eight cases were false positive (non-atypical hyperplasia at cytology, negative at biopsy). In our population, the cytology provided sufficient material more often than biopsy (P < 0.04). Sensitivity was estimated at 96%, specificity at 98%, positive predictive value at 86% and negative predictive value at 99%. Conclusions: We concluded that endometrial cytology may be an efficient diagnostic method. It could be applied to selected patients solely or in association with ultrasonography. The combination of these two noninvasive procedures may improve their diagnostic accuracy and reduce unnecessary hysteroscopies, thereby producing benefits for women and society.Keywords: endometrial neoplasms, uterine neoplasms, cytodiagnosis, cytological techniques, ThinPrep, LBC, liquid-based cytology IntroductionEndometrial adenocarcinoma ranks fifth in incidence among malignancies in women, and it is the most frequent malignancy of the female genital tract in developed countries. The majority of the cases are sporadic whereas about 10% are hereditary. Most important among the latter, is the autosomal dominantly inherited non-polyposis colorectal cancer caused by mutation of a DNA mismatch repair gene that determines constitutive microsatellite instability and Cowden syndrome in patients with germ line PTEN inactivation. Two subtypes of endometrial carcinoma, named type I and type II, have been described on the basis of their different age of development, aetiopathogenesis, histopathological features and prognosis. Type I adenocarcinoma, which accounts for most cases (approximately 80%), occurs in peri-menopausal women, is oestrogen dependent, more often well differentiated and endometrioid, and has a favourable behaviour with appropriate therapy. Conversely, the rare type II endometrial adenocarcinoma affects older postmenopausal wo...

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Liquid-based cytology represents an opportunity to re-evaluate endometrial cytology. We evaluated the accuracy of liquid-based endometrial cytology as compared to biopsy in 670 women scheduled for histeroscopy because of thickened endometrium (>4 mm), as evaluated by transvaginal sonography. Endometrial biopsy detected pathology in 41 (6%) of cases (21 of which were adenocarcinomas). Cytologic study found pathology in 62 (9%) cases (19 of which were adenocarcinomas). Two hundred ninety-one biopsies (43%) and 28 (4%) cytologies were inadequate. The sensitivity and the specificity were estimated, respectively, at 95% and 98%; the positive and negative predictive values were estimated, respectively, at 83% and 99%. Cytology provided sufficient material more often than biopsy (P < 0.01). We consider endometrial cytology an efficacious diagnostic opportunity. It could be usefully applied in association with transvaginal sonography. The combination of these procedures might reduce more invasive and expensive diagnostic procedures. Diagn. Cytopathol. 2007;35:398-402. ' 2007 Wiley-Liss, Inc.Key Words: thin-layer; liquid-based; endometrial cytology; endometrial adenocarcinoma; endometrial hyperplasia Endometrial adenocarcinoma is the most common malignancy of the female genital tract. A significant increase in its frequency, both absolute and relative, has been observed during the last decades. This increase is considered the consequence of the extended life expectancy of women, the increase in the incidence of risk factors, and of the reduction of invasive cervical carcinomas. Nowadays, more than 1 in 20 female cancers in Europe are of the endometrium. [1][2][3][4][5][6][7][8][9][10] Contrary to cervical carcinoma, no screening programs have been organized for the early detection of endometrial adenocarcinoma. The lack of screening programs may be related to the precocious presenting symptoms and to the relative good prognosis of the majority of endometrial adenocarcinomas. Early abnormal uterine bleeding, the commonest presenting symptom for the 95% of women, allows diagnosis at stage I in 73% of cases. 11 Moreover, there has not been an endometrial test comparable to cervicovaginal cytology for diagnostic reliability, tolerability, and low cost.Several diagnostic procedures are used for investigating the endometrium, but there is no common agreement for the optimum approach in each circumstance (i.e. symptomatic vs. asymptomatic; with risk factors vs. without risk factors).Endometrial cytology has been hampered in its dissemination by the difficulty in its interpretation due to the common presence of excess blood and overlapping cells. Liquid-based cytology represents an opportunity to reexamine endometrial cytology. We conducted the current study to correlate the results of liquid-based endometrial cytology with the results of endometrial biopsy in a group of 670 women scheduled for hysteroscopy because of thick endometrium (>4 mm), as evaluated by transvaginal sonography (TVS). Our purpose was preliminarily to asce...

The proper management of endometrial polyps still represents a clinical ongoing challenge, especially when they are asymptomatic and occasionally discovered. The aim of this study was to evaluate liquid-based endometrial cytology to manage endometrial polyps in postmenopausal age by its ability to exclude hidden premalignant and malignant changes within polyps. Three hundred fifty-nine consecutive postmenopausal patients who underwent hysteroscopic diagnosis of endometrial polyp over a 3-year period and who were scheduled for surgical removal within the three subsequent months were retrospectively evaluated. Histologic results after resection during operative hysteroscopy or during hysterectomy were compared with liquid-based cytology and endometrial biopsy obtained at the time of diagnostic hysteroscopy. Eight of 359 patients (2.2%) had malignant or premalignant polyps interpreted as benign finding at hysteroscopy. Unsatisfactory samples were higher for endometrial biopsy compared to liquid-based cytology in the whole series and in the subgroup of low-risk asymptomatic patients (P < 0.001). Endometrial biopsy and liquid-based cytology revealed a sensitivity of 62% and 87.5%, respectively and a 100% specificity. Considering the subgroup of low-risk asymptomatic patients, liquid-based cytology disclosed all the five pathologic lesions with a 100% sensitivity and specificity. In conclusion, liquid-based cytology proved to be a useful tool to establish the nature of endometrial polyps in postmenopausal patients. Complete removal of the lesion should be offered to all symptomatic patients and those with established risk factors for endometrial cancer. Conversely, a wait and see attitude should be considered in case of asymptomatic low-risk polyps with typical appearance on hysteroscopy and negative liquid-based cytology.